Medication compliance is a critical component in the success of any medical treatment. However, a recent review of 139 studies reporting compliance data showed that only 63% of patients continue with their medication after a year and patients take their medication only 72% of the time. The World Health Organization envisions a more pessimistic scenario estimating that only 50% of patients follow their doctors' prescriptions. The scenario is even more worrying for the elderly, where the levels of noncompliance may reach 75%.
In order to tackle this challenge, medical experts have tried a variety of strategies that remind patients to take their medication, including: (1) counseling, (2) simplified regimen plans, and (3) compliance aids.
The counseling strategy focuses on patient education, including risk factors of non-compliance, information about their illness, instructions on how to take the prescribed medication correctly, and explanations of the benefits and possible adverse effects of the therapy. This method has been extensively applied yielding mixed results in different studies. For instance, Russell et al. identified that 21 out of 42 studies on counseling interventions did not reveal any difference between treatment and control groups, while the remaining 21 studies did (Russell, C. L.; Conn, V. S.; Jantarakupt, P. “Older adult medication compliance: integrated review of randomized controlled trials”. American Journal of Health Behavior 30, 2006).
Simplified regimen plans include drug reminder charts, calendar packaging, and dosage boxes. These studies reveal that this strategy alone is unlikely to improve drug compliance.
Finally, compliance aid has proven to be one of the most effective strategies to date. For instance, telephone follow-ups by the pharmacist were extensively tested and proven to be effective in enhancing medication compliance while also reducing the overall cost to the health provider. However, this intervention method does not scale well for a large population on a long-term basis. Many simpler reminders are available on the market, such as the e-Pill Multi-alarm Pocket, the 6-alarm vibrating watch, and the GlowCaps pillbox which also record date and time every time it is opened (similar to MEMS). Still, previous work reports cases in which no improvement in medication compliance was observed by using reminders alone, or even where automated reminders were perceived negatively by the users.
Combinations of these strategies have been frequently proposed in the literature with the assumption that a single approach cannot be effective for all patients. An example is the use of both counseling strategies and compliance aids to trigger the patients' motivation towards adherence to medication. However, this approach has been shown to be ineffective in a few cases according to both objective and subjective measures.
The main problem in current medication compliance strategies is that they mainly focus on reminding patients of something they already know they have to do, without engaging them in doing it by themselves.
In fact, the mobile and pervasive technologies that have been proposed to tackle this challenge are mainly in the form of memory aid solutions that remind patients to take their pills. However, these methods do not engage patients in shifting their behavior towards better compliance. In fact, alerting patients to do the same thing every day does not engage them in actually doing it themselves.